Provider Demographics
NPI:1437797966
Name:FLORES, MADISON (MS, CPC)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:FLORES
Suffix:
Gender:F
Credentials:MS, CPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5940 S RAINBOW BLVD
Mailing Address - Street 2:STE 400 #122630
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-2507
Mailing Address - Country:US
Mailing Address - Phone:702-723-0793
Mailing Address - Fax:
Practice Address - Street 1:5940 S RAINBOW BLVD
Practice Address - Street 2:STE 400 #122630
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-2507
Practice Address - Country:US
Practice Address - Phone:702-723-0793
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-16
Last Update Date:2024-10-01
Deactivation Date:2021-10-19
Deactivation Code:
Reactivation Date:2021-11-05
Provider Licenses
StateLicense IDTaxonomies
106S00000X
NVCP5710101YP2500X
NVCI5050101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician